Varicella Infection Research Articles

Raised Intracranial Pressure in an Obese Female Due to VZV Meningitis

Initial infection with VZV causes varicella (or 'chickenpox'). This is a primary infection which can then lie dormant in sensory ganglion cells; when reactivated it is termed herpes zoster [1]. Common reported neurological complications of primary varicella infection are meningoencephalitis and acute cerebellar ataxia [2].

Prevalence of infectious diseases in preterm infants: a 2-year follow-up from the Japan Environment and Children’s Study

Evidence regarding the long-term risk of infections in preterm infants is lacking. In this study, we examined whether preterm infants developed various common childhood infections more frequently than full-term infants by the age of 2 years by analyzing data from a questionnaire completed by 67,282 mother–toddler pairs in a nationwide birth cohort study. Of the target population, 2885 (4.3%) were born prematurely. After covariate adjustment for maternal and children factors, lower respiratory tract infections appeared more frequent in preterm than in full-term infants at both 1 and 2 years (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 1.05–1.41, and aOR 1.27, 95% CI 1.11–1.46, respectively). However, there was no significant difference in the frequencies of lower respiratory tract infection between preterm and full-term infants after Palivizumab administration. The risk of other common infections, such as in the upper respiratory tract infection, otitis media, urinary tract infection, gastroenteritis, herpangina, hand-foot-and-mouth disease, chickenpox, influenza virus, and adenovirus infections, was not higher in preterm than in full-term infants after covariates adjustment for maternal and children factors. These findings suggest Palivizumab prophylaxis could reduce the frequencies of lower respiratory tract infection in preterm to the same level as in full-term infants.

109. Seroprevalence of Protective Antibodies against Varicella, Hepatitis-A and Dengue among Indian Children, Adolescents and Adults

Abstract Background Varicella, Hepatitis-A and Dengue cause significant disease burden in our country. Estimation of age-wise seroprevalence of antibodies against these diseases not only help us in understanding age-specific incidence rates and susceptibility, but also help policy makers in deciding need and timing of vaccination. None of these vaccines are part of current national immunization program in India, yet. Methods In this observational cross-sectional study, apparently healthy children (9-12 years), adolescents (15-18 years) and adults (25-30 years) attending OPD of a tertiary care hospital in Northern India over two-year period (July 17- June 19) were enrolled after taking informed written consent, and their 3-ml venous blood sample was collected. Ethical clearance was obtained from Institute Ethics committee, before enrolling subjects. Serum was tested for IgG antibodies using specific commercial ELISA kits. Those who received received Hepatitis-A or Varicella vaccination in past were excluded from enrollment. Results Out of total 240 subjects (M:F=117:123) enrolled, 75 were children, 75 adolescents and 90 adults in specified age groups. Mean age in these three groups were 11.04, 16.52 and 26.53 years respectively. In our study, antibodies (IgG) against Varicella were >12 U/ml (seroprotective) in 36% (27/75), 74.6% (56/75), 64.5% (58/90) in children, adolescent and adults in specified age groups, respectively. Similarly, the antibodies (IgG) against Hepatitis-A were >10 U/ml (seroprotective) in above three groups were 68% (51/75), 85.3% (64/75), 95.5% (86/90). For dengue IgG antibodies also, seropositivity rates in above three groups were 37.3% (28/75), 62.7% (47/75), 53.3% (48/90). Conclusion Large proportion of children, adolescents and adults remain susceptible to Varicella and Hepatitis-A infection in India. Early childhood vaccination with Varicella and Hepatitis-A vaccines should be a part of National Immunization Programme in India, as a part of preventive strategy. Our study also showed a large proportion of children, adolescents and adults remain seronegative for Dengue antibodies in various age groups. Therefore, if currently available dengue vaccine (Dengvaxia) has to be used in our population, it can only be used after individual screening. Disclosures All Authors: No reported disclosures.

Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children.

In west and central Africa, monkeypox occurs mainly in older children, adolescents and young adults. In two large epidemiology studies of monkeypox outbreaks, the investigators observed a sizable number of coinfections of chickenpox (varicella) and monkeypox. Based on a review of the literature, we propose that chickenpox (human herpesvirus-3 infection) is a risk factor for acquisition of monkeypox infection. Our hypothesis states that the chickenpox skin lesion provides an entry site for the monkeypox virus, which is harbored on a fomite in the environment of the patient. The fact that monkeypox can enter via a scratch or abrasion is a known mechanism of spread for three other poxviruses, including mousepox (ectromelia), orf and molluscum contagiosum. There are many similarities in pathogenesis between certain poxviruses and chickenpox, including a viremia with a cellular stress response leading to high levels of the IL-6 cytokine. One very revealing observation in the two epidemiology studies was that the number of pox as well as the severity of disease in children with chickenpox and monkeypox coinfection was not greater than found in children with monkeypox alone. Based on the above observations, we conclude that, when chickenpox precedes monkeypox, priming of the immune system by the earlier chickenpox infection moderates the severity of the secondary infection with monkeypox. This conclusion also has important public health implications about chickenpox surveillance.

Active circulation of varicella zoster virus among different age groups in Sudan.

In Sudan, data on varicella infections are lacking and the vaccine is currently not in use. The aim of this study was to investigate previous exposure to varicella zoster virus (VZV) among children and adults from the general population and among health-care workers (HCWs) in Khartoum. Dried blood spot samples collected between 2015 and 2016 from 294 children aged 1‒15 years, 153 adult volunteers and 241 HCWs were investigated for the presence of VZV IgG antibodies using ELISA. The overall seroprevalence of VZV IgG antibodies among the investigated cohorts was 50.4%, ranging between 14.3% in children and 79.3% in HCWs. Seropositivity increased with age among children and HCWs (P ⩽ 0.05). A relatively low seropositivity (64.7%) was observed among young adults and HCWs, suggesting that a high proportion of Sudanese adults remain susceptible. In hospital settings, this result implies a risk of nosocomial infection involving both HCWs and vulnerable patients. The results of this first VZV study in Sudan suggest active virus circulation in different age groups. Especially HCWs at the start of their career might benefit from vaccination, not only to save themselves from herpes zoster and its sequelae, but also to indirectly protect vulnerable patients.

Prevention of Herpes Zoster: A Focus on the Effectiveness and Safety of Herpes Zoster Vaccines.

Infection with varicella zoster virus typically occurs in children and it can cause primary varicella infection or "chickenpox", or it can reactivate later in life and cause herpes zoster or "shingles". Herpes zoster mainly occurs in older adults, causing a reduction in activities of daily living, impacting quality of life, and may lead to serious complications, including chronic pain. Two vaccines are marketed to prevent herpes zoster: the live zoster vaccine and the non-live, recombinant zoster vaccine. The pre-licensure clinical trials show the efficacy of the live zoster vaccine to be between 50 and 70% and for the recombinant vaccine to be higher at 90 to 97%. Real-world effectiveness studies, with a follow-up of approximately 10 years, were reviewed in this article. These data corroborated the efficacy studies, with vaccine effectiveness being 46% and 85% for the live and recombinant vaccines, respectively. Safety data from the effectiveness studies show similar results to the clinical trials with mostly local injection-site reactions and mild systemic reactions seen with both vaccines, although in larger proportions with the recombinant vaccine. Rare adverse events, occurring less than 1% of the time, have been seen with both vaccine types and include disseminated herpes zoster with the live zoster vaccine and Guillain-Barré syndrome with the recombinant vaccine. The wider use of preventative measures with vaccines will reduce the herpes zoster burden of illness seen in older adults.

Skin Necrosis in a Patient with Protein S Deficiency, Warfarin Anticoagulation, and Acute COVID-19 Infection: A Case Report

Abstract Introduction/Objective Although thrombotic complications from COVID are well documented, the pathophysiology remains poorly understood, especially in patients with comorbid hypercoagulable risk factors and anticoagulant medication use. COVID has several dermatologic manifestations that may occur due to alterations in hemostasis. We present a case of skin necrosis in a patient with protein S deficiency, warfarin anticoagulation, and acute COVID infection. Methods/Case Report A 48-year-old female, BMI >50, heterozygous Protein S (PS) deficiency, Factor V Leiden, and history of recurrent venous thromboembolic events on warfarin, tested positive for COVID. Her only symptom was fatigue. Several days later, the patient developed painful ecchymoses and erythematous blisters on her breast, arm, and abdomen. Laboratory results showed INR 3.6, fibrinogen 675-1054 gm/dL, WBC 15k with absolute neutrophilia, and D-dimer 2274 ug/L DDU. The patient confirmed compliance with her maintenance warfarin dose. Biopsy showed thrombotic vasculopathy without leukocytoclastic vasculitis. Wound cultures were negative. Results (if a Case Study enter NA) NA. Conclusion The patient’s history and presentation were concerning for warfarin induced skin necrosis. However, the patient had taken warfarin for > 20 years and had an INR of 3.6 which substantiated that warfarin was not discontinued or missed. A retrospective review of INR results during acute COVID infection showed a decrease in time in therapeutic range and an increase in supratherapeutic INRs, suggesting COIVD patients may require decreased warfarin doses. Additionally, PS levels decline in patients with COVID; a similar effect is seen with HIV and Varicella infections. It is theorized that this may be mediated by an increase in C4b binding protein, an acute phase reactant that regulates the complement cascade and binds PS. With an infectious source ruled out and the patients’ known comorbid conditions, an acute exacerbation of the patients underlying hypercoagulable state is the likely driver of the patient’s skin necrosis with COVID as the probable precipitator. In summary, inherited and acquired hypercoagulable risk factors should be included in the differential diagnosis as a cause of skin changes in patients with COVID infection. Although histology may be helpful in diagnosing the cause of skin changes with COVID, laboratory results and clinical correlation are key in identifying a etiology.

The health and economic impact of switching vaccines in universal varicella vaccination programs using a dynamic transmission model: An Israel case study

ABSTRACT Currently available health economic models for varicella infection are designed to inform the cost-effectiveness of universal varicella vaccination (UVV) compared with no vaccination. However, in countries with an existing UVV program, these models cannot be used to evaluate whether to continue with the current varicella vaccine or to switch to an alternative vaccine. We developed a dynamic transmission model that incorporates the historical vaccination program to project the health and economic impact of changing vaccination strategies. We applied the model to Israel, which initiated UVV in 2008 with a quadrivalent vaccine, MMRV-GSK, and switched to MMRV-MSD in 2016. The model was calibrated to pre-vaccination incidence data before projecting the impact of the historical and future alternative vaccination strategies on the clinical burden of varicella. Total costs and QALYs lost due to varicella infections were projected to compare continuing with MMRV-MSD versus switching to MMRV-GSK in 2022. Over a 50-year time horizon, continuing with MMRV-MSD reduced varicella incidence further by 64%, reaching 35 cases per 100,000 population by 2072, versus a 136% increase in incidence with MMRV-GSK. Continuing with MMRV-MSD reduced cumulative hospitalization and outpatient cases by 48% and 58% (vs. increase of 137% and 91% with MMRV-GSK), respectively. Continuing with MMRV-MSD resulted in 139 fewer QALYs lost with total cost savings of 3% compared with switching to MMRV-GSK, from the societal perspective. In Israel, maintaining the UVV strategy with MMRV-MSD versus switching to MMRV-GSK is projected to further reduce the burden of varicella and cost less from the societal perspective.

THE RESULTS OF THE ANALYSIS OF THE COMPOSITION OF PATIENTS HOSPITALIZED IN THE DEPARTMENTS OF SURGICAL AND THERAPEUTIC PROFILE OF MULTIDISCIPLINARY MEDICAL ORGANIZATIONS

Relevance. Currently, more attention is being paid to improving the quality of drug provision for multidisciplinary medical organizations. An objective analysis of factors, including the analysis of the structure of the composition of patients hospitalized in multidisciplinary medical organizations, is of great importance. Aim. To analyze the composition of patients hospitalized in the departments of therapeutic and surgical profile of multidisciplinary medical organizations. Materials and methods. Materials: statistical reports, journals of the movement of medicines and prescribing lists of medical histories of patients examined by multidisciplinary medical organizations, as well as data on standards of medical care and clinical recommendations. Methods: retrospective analysis, methods of comparison, correspondence, etc. Results. This article presents the results of the analysis of the morbidity structure of patients hospitalized in surgical and therapeutic departments of multidisciplinary medical organizations of the research base, which revealed that the most common diseases in these multidisciplinary medical organizations are respiratory diseases (Class X), circulatory system (Class IX) and digestive organs (Class XI). The analysis of the categories of the most common classes of diseases according to ICD-10 in each multidisciplinary medical organization showed the most common nosological forms in each category of ICD-10. For example, in the structure of diseases under the headings of Class I "Infectious and parasitic diseases" in all multidisciplinary medical organizations, the research base showed the predominance of the following nosological forms: chickenpox (B01) and acute intestinal infections caused by unidentified infectious agents (A09). Conclusion. To improve the quality of medical care, special attention should be paid to the compliance of the drug provision of multidisciplinary medical organizations with the structure of the morbidity of patients admitted to it.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2021.

The Australian Paediatric Surveillance Unit (APSU) has been conducting surveillance of rare communicable and non-communicable conditions in children since its inception in 1993. In this report, the results are described of surveillance of ten communicable diseases (and complications) for 2021, including the numbers of cases and incidence estimates; demographics; clinical features; and management and short-term outcomes. The included diseases are: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV); neonatal herpes simplex virus (HSV) infection; paediatric human immunodeficiency virus (HIV) infection; perinatal exposure to HIV; severe complications from influenza; juvenile-onset respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. In 2021, cases of JoRRP were reported to the APSU for the first time since 2017, indicating potential gaps in HPV vaccination. AFP surveillance by APSU again contributed to Australia achieving a minimum target incidence of one AFP case per 100,000 children aged < 15 years. There were no cases of children with severe complications of influenza. No cases of varicella or congenital rubella were reported; however, at-risk populations, especially young migrant and refugee women from countries without universal vaccination programs, need to be screened and prioritised for vaccination prior to pregnancy. Cases of perinatal exposure to HIV continue to increase; however, the rate of mother-to-child-transmission remains at low levels due to the use of effective intervention strategies. Case numbers of congenital CMV and neonatal HSV remain steady in the absence of vaccines, prompting the need for greater awareness and education, with recent calls for target screening of at-risk infants for congenital CMV.

Congenital and Perinatal Varicella Infections.

Varicella-zoster virus (VZV) is a human pathogen of the α-herpesvirus family. Some fetuses infected in utero around 8-20 weeks of pregnancy show signs of congenital varicella syndrome (CVS). Infants born to mothers who develop varicella within 5 days before and 2 days after delivery can experience severe disease with increased mortality. The best diagnostic modality is polymerase chain reaction (PCR), which can be done using vesicular swabs or scrapings, scabs from crusted lesions, tissue from biopsy samples, and cerebrospinal fluid. The prevention and management of varicella infections include vaccination, anti-VZV immunoglobulin, and specific antiviral drugs. In this article, we have reviewed the characteristics of VZV, clinical manifestations, management of perinatal infections, and short- and long-term prognosis.

Dysgeusia

Bitter taste dysgeusia is a rare symptom where patients experience all foods as bitter. While its cause is still unknown, it has been increasingly reported in infections. The altered taste sensation associated with herpes zoster infection is not uncommon. However, it is rare in primary varicella infections. In this case report, we present what we believe to be the first case of bitter taste dysgeusia presenting as a prodromal symptom in primary varicella zoster infection.

The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia.

Background: Despite the substantial burden of varicella infection, Slovenia does not currently have a universal varicella vaccination (UVV) program. We modeled the long-term clinical and economic impact of implementing 2-dose UVV strategies compared with no vaccination in Slovenia. Methods: A previously published dynamic transmission model was adapted to the demographics, varicella seroprevalence, herpes zoster incidence, and contact patterns in Slovenia. Six 2-dose UVV strategies, vs no vaccination, were considered over a 50-year period, including monovalent vaccination (Varivax® [V-MSD] or Varilrix® [V-GSK]) at ages 12 and 24 months, or monovalent vaccination at 15 months followed by monovalent or quadrivalent vaccination (ProQuad® [MMRV-MSD] or Priorix- Tetra® [MMRV-GSK]) at 5.5 years. Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios vs no vaccination were calculated to assess the economic impact of each strategy from payer and societal perspectives. Results: The incidence of varicella infection was estimated as 1228 per 100 000 population in the absence of UVV. Over 50 years, depending on vaccination strategy, UVV reduced varicella cases by 77% to 85% and was associated with substantial reductions in varicella deaths (39%-44%), outpatient cases (74%-82%), and hospitalizations (74%-82%). The greatest reductions were predicted with V-MSD (15 months/5.5 years) and V MSD/MMRV-MSD (15 months/5.5 years). Discussion: All 2-dose UVV strategies were cost-effective compared with no vaccination from payer and societal perspectives, with V-MSD (15 months/5.5 years) being the most favorable from both perspectives. Conclusion: Policymakers should consider implementing UVV to reduce the burden of varicella disease in Slovenia.

The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia

Background: Despite the substantial burden of varicella infection, Slovenia does not currently have a universal varicella vaccination (UVV) program. We modeled the long-term clinical and economic impact of implementing 2-dose UVV strategies compared with no vaccination in Slovenia. Methods: A previously published dynamic transmission model was adapted to the demographics, varicella seroprevalence, herpes zoster incidence, and contact patterns in Slovenia. Six 2-dose UVV strategies, vs no vaccination, were considered over a 50-year period, including monovalent vaccination (Varivax® [V-MSD] or Varilrix® [V-GSK]) at ages 12 and 24 months, or monovalent vaccination at 15 months followed by monovalent or quadrivalent vaccination (ProQuad® [MMRV-MSD] or Priorix- Tetra® [MMRV-GSK]) at 5.5 years. Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios vs no vaccination were calculated to assess the economic impact of each strategy from payer and societal perspectives. Results: The incidence of varicella infection was estimated as 1228 per 100 000 population in the absence of UVV. Over 50 years, depending on vaccination strategy, UVV reduced varicella cases by 77% to 85% and was associated with substantial reductions in varicella deaths (39%-44%), outpatient cases (74%-82%), and hospitalizations (74%-82%). The greatest reductions were predicted with V-MSD (15 months/5.5 years) and V MSD/MMRV-MSD (15 months/5.5 years). Discussion: All 2-dose UVV strategies were cost-effective compared with no vaccination from payer and societal perspectives, with V-MSD (15 months/5.5 years) being the most favorable from both perspectives. Conclusion: Policymakers should consider implementing UVV to reduce the burden of varicella disease in Slovenia.

Purse-string suture combined with subcision and dermal graft for the treatment of wide depressed scars and boxcars.

Dermal layer injuries can result in depressed or indented scars even when there is no subcutaneous injury. These scars can result from acne, chickenpox, trauma, or skin infection. Several procedures, including primary closure, subcision, microneedling, and dermal grafting, have been reported to be used to treat depressed scars, boxcars, or acne cosmetics. These procedures have not, however, been shown to be very effective when applied to the treatment of deep depressed scars, boxcars, or acne cosmetics. In this retrospective study, we assessed scar improvement in patients with deep depressed facial scars and boxcars treated with our novel combination of techniques. This study included all patients treated for deep depressed scars and boxcars at our clinic from 2018 to 2021. To be included, patients had to present in our clinic for the treatment of deep depressed scars or boxcars, have no prominent subcutaneous layer injury, and have full set of clear pre-and post-procedure photographs. All patients initially received technique combination including scar subcision, inner purse-string suturing, and dermal grafting for the first stage surgery treatment. In cases of residual uneven superficial scars, laser dermabrasion resurfacing was used as second-staged treatment. Preoperative and six-month postoperative scar appearance photographs were assessed for improvement by our three nonmedical staff members and divided into four improvement groups, as minimal, moderate, good, and excellent. This study included a total of 24 patients (20 females and four males) with facial scarring. Two patients (8.3%) had moderate, 13 (54.2%) good and nine (37.5%) excellent improvement post-treatment. There were no instances of minimal improvement. Four patients received second stage laser dermabrasion resurfacing for residual uneven superficial scars. We concluded deep depressed scars and boxcars can be easily, safely, and effectively treated using our novel combined scar subcision, inner purse-string suturing, and dermal grafting treatment with possible second-staged laser dermabrasion, and without major complications.

Case Report: Account of chickenpox progression over 10 days

Chickenpox is an extremely contagious disease; caused by the varicella-zoster virus primary infection. A 27-year-old adult Black African male health care worker presented with severe headache, intermittent weakness and inability to walk, intermittent nausea, fever, nocturnal polydipsia, shortness of breath, itching, pruritus (intensely pruritic erythematous macules), lesions with pus on the skin, sleep disturbances, and nightmares for two days. The most commonly occurring symptom of chickenpox is a vesicular rash that appears on the scalp, back and front of the neck, face and scapulae, and then disseminates distally to the limbs. In this case report, the patient face, neck and scapulae were the most infected areas of the body and the rest of the body except the legs, hands, genital areas and buttocks, were also highly infected. Acyclovir 800 mg orally, five times a day was given for ten days to cure chickenpox infection because acyclovir inhibits the replication of the varicella zoster virus, and has the ability to eradicate varicella zoster virus and relieve the symptoms more readily.

Clinical manifestations, complications and management of chickenpox infection in pediatric

Chickenpox can be defined as a highly communicable viral infection caused by varicella zoster virus; most frequently influences pediatric in five to nine yrs old. The commonly occurred signs and symptoms of chickenpox are comprises vesicular rash appears on the scalp, face and trunk, and then disseminates distally to limbs (centrifugal distribution). The most common complications of chickenpox are bacterial soft-tissue infection, pneumonia, and encephalitis. Encephalitis is a most commonly occurred central nervous system complications expose the pediatric to other problems or death. The main goal chickenpox infection management in children is to alleviate the symptoms such as skin infections, fever, itching etc and making the children confortable. Adequate intravenous acyclovir administration is crucial for successful management of chickenpox, but it must be administered within twenty-four hrs. after the onset of the disease. Management of chickenpox with oral acyclovir given within twenty four hrs of onset of rash may be more effective.

Awareness and preparedness of human monkeypox outbreak among university student: Time to worry or one to ignore?

BackgroundThe growing number of human monkeypox cases worldwide illustrates the importance of early detection, prevention, management and quick action from healthcare authorities. The WHO confirmed a hundred of Monkeypox cases worldwide and disclosed Monkdypox as a worldwide emergency situation ObjectivesTo assess the knowledge about human monkeypox’ source, signs/symptoms, transmission, prevention and treatment among Al Ain university students in the UAE. MethodsThis descriptive cross-sectional study aimed to assess Al Ain University students’ knowledge of Human Monkeypox. A validated questionnaire was distributed to students between lectures. The respondents’ knowledge of human Monkeypox was assessed by 21 questions that examined the participants’ knowledge of Monkeypox as follows: 5 items examined knowledge of the source, definition, and incubation time; 2items assessed the mechanism of transmission of human Monkeypox, 7 items assessed the signs and symptoms; 7 items assessed the preventative measures; and 6 items assessed the treatment modalities. A multivariate logistic regression model was used to identify the factors influencing respondents’ knowledge of human Monkeypox among university students. ResultsA total of five hundred and fifty-eight (558) students participated in the study. The average knowledge score was 70.1%, with a 95% confidence interval (CI) of 68.9 − 71.3. Of the total participants, 111 (19.9%) had poor knowledge about human Monkeypox, 320 (57.3%) had moderate knowledge, and 127 (22.8%) had good knowledge. The results of the statistical modelling showed that Old age (OR 0.681; 95% CI 1.005–1.016), female gender (OR 1.26; 95% CI 0.813 –0.961), participants from medical colleges (OR 1.22; 95% CI 1.13 –1.32) having a history of human chickenpox infection (OR 2.6; 95% CI 2.3–2.9) and receiving information on human Monkeypox during education (OR 1.14; 95% CI 1.05–1.2) were strong determinants for good knowledge about human Monkeypox. Conclusionknowledge of Monkeypox among the participants is relatively low, particularly regarding the epidemiology, symptoms and treatments. Therefore, increasing knowledge of Monkeypox will be key to enhancing the capacity to respond to human monkeypox cases and to relay pertinent data to a disease surveillance system.

Temporal trends in hospitalisation for opportunistic infections in lupus patients in Western Australia.

Lupus patients often require aggressive immunosuppressive therapy, which increases the risk for infections. We studied the temporal rates for opportunistic infections (OI) and associated mortality in lupus patients hospitalised in Western Australia. All patients hospitalized in the period 1985-2015 with ≥2 ICD based diagnostic codes for SLE were included. OI was defined as a microbiologically confirmed mycobacterial, fungal, or viral infection. Descriptive data are given as median (IQR) and frequency (%) with incidence rates (IR) calculated per 1000 person years and IR trend rates analysed across 10-year periods by least square regression (R2). The study cohort (n = 1408) contained 85.3% females with age at entry 35years (IQR 22-51). During median follow-up of 21.1years (IQR 17.5-29.6) hospitalisation for OI occurred in 121 (8.6%) patients with recurrent or multiple OI observed in 42 (34.7%) patients. During 29.771 thousand person years, a total of 295 OI were diagnosed for an overall IR rate of 9.91 (CI 8.82-11.09)/1000 person years which did not decrease significantly over time (R2 0.14). Significant decreases were however seen in the IR for tuberculosis (R2 0.88), cryptococcal (R2 0.98) and pneumocystis (R2 0.98) infections, with increasing IR observed for other mycobacteria (R2 0.99) and aspergillosis (R2 0.55) and little change seen for H Zoster (R2 0.18) and Varicella (R2 0.10) infections. In-hospital death during OI admission occurred in 9/121 patients (7.4%). There was no significant gender difference in IR or outcome of OI. Hospitalization rates for OI in lupus patients have not changed significantly over time, but there has been a clear shift in the underlying OI. The decrease in mycobacterial and pneumocystis infections suggest successful prophylaxis but the increase in viral and mycotic infections indicate a sustained need to improve prevention of these OI in lupus patients.

Is Aberrant DNA Methylation a Key Factor in Molar Incisor Hypomineralization?

Molar incisor hypomineralization (MIH) is a qualitative disturbance of the enamel of the permanent molars and/or incisors. Its etiology is not clearly defined but is connected with different factors occurring before and after birth. It remains difficult to identify a single factor or group of factors, and the problem is further complicated by various overlapping mechanisms. In this study, we attempted to determine whether DNA methylation—an epigenetic mechanism—plays a key role in the etiology of MIH. We collected the epithelium of the oral mucosa from children with MIH and healthy individuals and analyzed its global DNA methylation level in each child using a 5-mC DNA ELISA kit after DNA isolation. There was no statistically significant difference between the global DNA methylation levels in the study and control groups. Then, we also analyzed the associations of the DNA methylation levels with different prenatal, perinatal, and postnatal factors, using appropriate statistical methods. Factors such as number of pregnancies, number of births, type of delivery, varicella infection (under 3 years old), and high fever (under 3 years old) were significantly important. This work can be seen as the first step towards further studies of the epigenetic background of the MIH etiology.